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Before removal, the portion of the bowel to be resected must be freed or mobilized. This is done by dissection and removal of the mesentery and other peritoneal attachments. Resection of any part of the colon entails mobilization and the cutting and sealing, or ligation, of the blood vessels supplying the portion of the colon to be removed. [8]
The Hartmann's procedure with a proximal end colostomy or ileostomy is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon. During this procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a stoma .
The colon is then mobilized from the retroperitoneum. Care is taken to avoid injury to the ureters and duodenum. The surgery then follows the same steps as small bowel resection. However, due to the colon's placement in the retroperitoneum, more dissection is often required to allow for tension free anastomosis. [5] [6]
The sigmoid colon is completely surrounded by peritoneum (and thus is not retroperitoneal), which forms a mesentery (sigmoid mesocolon), which diminishes in length from the center toward the ends of the loop, where it disappears, so that the loop is fixed at its junctions with the iliac colon and rectum, but enjoys a considerable range of movement in its central portion.
The sigmoid colon is the part of the large intestine after the descending colon and before the rectum. The name sigmoid means S-shaped (see sigmoid; cf. sigmoid sinus). The walls of the sigmoid colon are muscular and contract to increase the pressure inside the colon, causing the stool to move into the rectum.
APRs involves removal of the anus, the rectum and part of the sigmoid colon along with the associated (regional) lymph nodes, through incisions made in the abdomen and perineum. The end of the remaining sigmoid colon is brought out permanently as an opening, called a stoma , which is used by the patient in conjunction with a colostomy pouch, on ...
Proctocolectomy is the surgical removal of the entire colon and rectum from the human body, leaving the patients small intestine disconnected from their anus. [1] It is a major surgery that is performed by colorectal surgeons, however some portions of the surgery, specifically the colectomy (removal of the colon) may be performed by general surgeons. [2]
The original pull-through procedure was designed by Orvar Swenson and his colleague Alexander Bill. The abnormal aganglionic part of the bowel is resected down to the sigmoid colon and rectum, and the normal colon and the low rectum are subsequently joined.
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